Choosing%20a%20Method%20of%20Qualitative%20Synthesis

1
Choosing a Method of Qualitative Synthesis

• Dr Andrew Booth

2
Caveat Reviewer Pandoras Box!
3
Confusing Terminology, Variety of Choices

1. Qualitative Systematic Review
2. Qualitative Meta-Synthesis
3. Qualitative Research Synthesis
4. Qualitative Evidence Synthesis
5. Qualitative Interpretive Meta-Synthesis

• Best Fit Synthesis
• Critical Interpretive Synthesis
• Framework Synthesis
• Meta-Aggregation
• Meta-Ethnography
• Meta-Interpretation
• Meta-Narrative
• Meta-Study
• Meta-Summary
• Narrative Synthesis
• Qualitative Meta-Synthesis
• Realist Synthesis
• 19. Rapid Realist Synthesis
• Thematic Synthesis

4
Decisions, Decisions!

• Novice Bewildering variety of methods of
  synthesis compounded by choice of checklists,
  conflicting guidance etcetera
• Experienced - Many authors stick to familiar
  methods rather than select most appropriate
  method to address question and type of evidence
• Much description of methods, little evaluation
  and critique
• Much hiding behind labels, misuse of methods

5
Caveat Reviewer

• TREAD Carefully
• Time/Timeframe
• Resources
• Expertise
• Audience Purpose
• Data Quality, Quantity, Thickness, Richness

6
Time/Timeframe

• Most Time Consuming
• Meta-ethnography interpretive approach
• Realist Synthesis Identification of theory and
  development of programme theories

• Least Time Consuming
• Meta-Aggregation aggregating existing themes
• Thematic Synthesis inductively coding themes
• Framework Synthesis
• Best Fit Framework Synthesis

Framework-based synthesis is an important
advance in conducting reviews of qualitative
synthesis. The 'best fit' strategy is a variant
of this approach that may be very helpful when
policymakers, practitioners or other decision
makers need answers quickly, and are able to
tolerate some ambiguity about whether the answer
is the very best that could be given.
Dixon-Woods M. Using framework-based synthesis
for conducting reviews of qualitative studies.
BMC Med. 2011 Apr 14939.
7
Seven steps for meta-ethnography
8
Process of Realist Synthesis fromMcCormack,
B., Wright, J., Dewar, B., Harvey, G.,
Ballantine, K. (2007). A realist synthesis of
evidence relating to practice development
findings from the literature analysis. Practice
Development in Health Care, 6(1), 25-55.
9
Resources

• Most Resource Intensive

• Least Resource Intensive

10
Expertise

• Expertise in Qualitative Research Methods (e.g.
  Grounded Theory Framework Analysis, Thematic
  Analysis)
• Expertise in Synthesis Methods (incl. Searching,
  Data Extraction, Quality Assessment,
  Interpretation)
• Knowledge of Topic Area

11
Audience Purpose

• output of some methods (Thematic Synthesis,
  textual Narrative Synthesis, Framework Synthesis,
  and ecological triangulation) is more directly
  relevant to policymakers and designers of
  interventions thanmethods with a more
  constructivist orientation (Meta-Study,
  Meta-Narrative, Meta-Ethnography, Grounded
  Theory, CIS)generally more complex and
  conceptual (Barnett-Page Thomas, 2009)

• Thematic Synthesis (including Meta-Aggregation)
  and Framework Synthesis produce findings that
  directly inform practitioners (Thomas Harden,
  2009)
• Interpretive approaches (e.g. CIS,
  Meta-Ethnography) produce a model that requires
  practitioners to interpret relevance and
  applicability to their own context
• Narrative Synthesis or EPPI-Centre (matrix)
  methods may help to integrate and present
  quantitative/qualitative work

12
Data Quality, Quantity, Thickness, Richness

• Rich, Thick Data
• Meta-ethnography characterised by data of high
  methodological quality, rich data and systematic
  presentation.
• Rich/Thick reports sustain Meta-Ethnography/Grou
  nded Theory may allow selective sampling/
  theoretical saturation

• Poor, Thin Data
• Qualitative data from thin studies (or textual
  responses to surveys) will not sustain
  interpretive approaches
• Limited to Meta-Aggregation, Thematic Synthesis,
  Framework Synthesis, Meta-Summary Narrative
  Synthesis type approaches

NB. Is Unit of Analysis Individual Study
(Meta-Aggregation, Thematic Synthesis) or Body
of Evidence (e.g. Meta-Narrative or Critical
Interpretive Synthesis approaches) or even Theory
(Framework Synthesis/Best Fit Synthesis)?
13
Overview of Approaches
Gough D, Thomas J, Oliver S. Clarifying
differences between review designs and methods.
Syst Rev. 2012 Jun 9128. doi
10.1186/2046-4053-1-28.
14
Choice of Synthesis (Adapted from Noyes Lewin,
2011)
To aggregate/ summarise/ integrate qualitative
data to address questions in relation to a
specific intervention review
Primarily to integrate and interpret qualitative
and quantitative evidence within a single
approach or integrated model. Can be used to
develop explanatory theory.
Meta-ethnography Grounded theory Thematic
analysis with theory generation
Framework synthesis
Realist Review EPPI Approach Matrix
Method Narrative Synthesis Bayesian
Synthesis Critical Interpretive synthesis
Thematic analysis without theory
generation Meta-aggregation Meta-summary
Best fit synthesis
Product Aggregated findings from source papers
Product Explanatory theory, analytical or
conceptual framework or interpretative
framework/mechanism
15
Some Examples
16
The Scenario

• HTA Report Systematic Review, Modelling
  Qualitative Synthesis on Group Therapy for
  Postnatal Depression (UK)
• Stevenson M, Scope A, Sutcliffe P, Booth A, et
  al. Group cognitive behavioural therapy for
  postnatal depression a systematic review of
  clinical effectiveness, cost effectiveness and
  value of information analyses. Health Technol
  Assess 201014(44).
• Scope, A., Booth, A. and Sutcliffe, P. (2012),
  Womens perceptions and experiences of group
  cognitive behaviour therapy and other group
  interventions for postnatal depression a
  qualitative synthesis. Journal of Advanced
  Nursing. doi 10.1111/j.1365-2648.2012.05954

17
The Choice

• Type of Question Acceptability of Intervention
• Extent of Description versus Interpretation
  Factors Making Group Therapy More or Less
  Acceptable (Descriptive)
• Role of Theory No Theory Trying to separate
  Group Effect from Therapy Effect
• Type of Data Very Thin Data, Small Number of
  Studies (n 6) Descriptive Case Study Accounts
  in Nursing Journals
• Intended Output Alongside Effectiveness Review
  Cost Effectiveness Study for Implementation
• Other Considerations
• Methodological Expertise in Team Novice
  Reviewer
• Available Resources Limited Time in Comparison
  to Main Review

18
Your Choice?
ST
19
The Contribution

• While Group Therapy is Acceptable on Average
  there are some for whom it is unfavourable
  because
• Group Comparison Some People are Getting Better
  Quicker than I am
• Group Comparison Ms. X has been Coming Here
  longer than I am and is still not any better
• Identified Key Issue Identification of those
  Most Likely to Benefit.

20
The Scenario

• Aim To analyse meaning and motivation of the
  Wish To Hasten Death in patients with chronic
  illness or advanced disease
• Monforte-Royo C, Villavicencio-Chávez C,
  Tomás-Sábado J, Mahtani-Chugani V, Balaguer A
  (2012) What Lies behind the Wish to Hasten Death?
  A Systematic Review. from the Perspective of
  Patients. PLoS ONE 7(5) e37117.
  doi10.1371/journal.pone.0037117

21
The Choice

• Type of Question Explanatory
• Extent of Description versus Interpretation
  Factors that Help to Explain a Phenomenon
  (Interpretative)
• Role of Theory Theory Generation
• Type of Data Contextually Rich Qualitative
  Research Reports Thick Data NB. 7 studies
• Intended Output Stand Alone Research Report for
  Enlightenment
• Other Considerations
• Methodological Expertise in Team Large
  Experienced Team with Qualitative Researcher
• Available Resources Extant Funded Project

22
Your Choice?
E/M
23
The Contribution

• Wish to hasten death (WTHD) is multifactorial
  construct with multiple meanings that do not
  necessarily imply genuine desire to hasten one's
  death or actually taking steps towards this.
• Wish to hasten death (WTHD) is a phenomenon that
  appears, among patients in advanced stages of
  illness, as response to extreme suffering that
  affects all aspects of their human existence.

24
The Scenario

• Aim To evaluate benefits and constraints of
  collaborative health-related research by
  researchers and those affected by the issues
  under study and/or those who would apply
  research results and to examine how variations in
  programme context and mechanisms influence the
  process and outcomes of collaborative health
  intervention research?
• Jagosh, J., Macaulay, A. C., Pluye, P., Salsberg,
  J., Bush, P. L., Henderson, J., ... Greenhalgh,
  T. (2012). Uncovering the benefits of
  participatory research Milbank Quarterly, 90(2),
  311-346.

25
The Choice

• Type of Question Explanatory
• Extent of Description versus Interpretation
  Factors that Help to Explain Variation in
  Outcomes
• Role of Theory Theory Exploration
• Type of Data Contextually Rich Quantitative
  and Qualitative Research Reports Thick Data
  NB. Twenty-three PR partnerships described in
  276 publications.
• Intended Output Explanatory Report for Multiple
  Funders
• Other Considerations
• Methodological Expertise in Team Large
  Experienced International Team of Experienced
  Researchers
• Available Resources Extant Funded Project

26
Your Choice?
S/R
27
The Contribution

• Used middle-range theory of partnership synergy
  to demonstrate how PR can (1) ensure culturally
  and logistically appropriate research, (2)
  enhance recruitment capacity, (3) generate
  professional capacity and competence in
  stakeholder groups, (4) result in productive
  conflicts followed by useful negotiation, (5)
  increase quality of outputs and outcomes over
  time, (6) increase sustainability of project
  goals, and (7) create system changes and new
  unanticipated projects and activities.
• Generated new insights into benefits of PR
  regarding conflicts and negotiation between
  stakeholders, program sustainability and
  advancement, unanticipated project activity, and
  generation of systemic change.

28
References - 1

• Barnett-Page E, Thomas J. Methods for the
  synthesis of qualitative research a critical
  review. BMC Med Res Methodol. 2009 Aug 11959.
• Booth, A, Papaioannou, D and Sutton, A J (2011).
  Systematic Approaches to a Successful Literature
  Review. SAGE publications
• Candy B, King M, Jones L, Oliver S. Using
  qualitative synthesis to explore heterogeneity of
  complex interventions. BMC Med Res Methodol. 2011
  Aug 2611124.

• Dixon-Woods M, Agarwal S, Young B, Jones D,
  Sutton A. (2004) Integrative approaches to
  qualitative and quantitative evidence. London
  Health Development Agency
• Gough, D, Oliver, S, Thomas J (2012) An
  Introduction to Systematic Reviews. London Sage
  Publications.
• Lorenc, T., Pearson, M., Jamal, F., Cooper, C.
  and Garside, R. (2012), The role of systematic
  reviews of qualitative evidence in evaluating
  interventions a case study. Res. Synth. Method,
  3 110.

29
References - 2

• Popay J, Roberts H, Sowden A, Pettticrew M, Arai
  L, Rodgers M, Britten N Guidance on the conduct
  of narrative synthesis in systematic reviews.
  http//www.lancs.ac.uk/fass/projects/nssr/2007 .
• Pope C, Mays N, Popay J Synthesizing Qualitative
  and Quantitative Health Evidence a Guide to
  Methods. Maidenhead Open University Press 2007.
   

• Ring N., Ritchie K, Mandava L, Jepson R. (2011) A
  guide to synthesising qualitative research for
  researchers undertaking health technology
  assessment and systematic reviews. NHS Quality
  Improvement Scotland and University of Stirling,
  Edinburgh.  
• Thomas J, Harden A (2009) Methods for the
  thematic synthesis of qualitative research in
  systematic reviews, BMC Medical Research
  Methodology 845